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Heart diseases
- 5. STRIATIONS NUCLEUS DISCS SARCOLEMMA SARC. RETIC. MITOCHONDRIA ENDOTHELIUM FIBROBLASTS GLYCOGEN A.N.P. www.freelivedoctor.com
- 6. S.A. Node AV Node Bundle of HIS L. Bundle, R. Bundle www.freelivedoctor.com
- 8. Anterior Lateral Posterior Septal www.freelivedoctor.com
- 10. CARDIAC AGING www.freelivedoctor.com Sigmoid-shaped ventricular septum Decreased left ventricular cavity size Increased left atrial cavity size Chambers Buckling of mitral leaflets toward the left atrium Fibrous thickening of leaflets Mitral valve annular calcific deposits Aortic valve calcific deposits Valves Atherosclerotic plaque Calcific deposits Increased cross-sectional luminal area Tortuosity Epicardial Coronary Arteries Amyloid deposits Basophilic degeneration Lipofuscin deposition Brown atrophy Increased subepicardial fat Increased mass Myocardium
- 11. CARDIAC AGING www.freelivedoctor.com Atherosclerotic plaque Elastic fragmentation and collagen accumulation Sinotubular junction calcific deposits Elongated (tortuous) thoracic aorta Dilated ascending aorta with rightward shift Aorta
- 12. BROWN ATROPHY, HEART www.freelivedoctor.com
- 22. LEFT Heart Failure Dyspnea Orthopnea PND (Paroxysmal Nocturnal Dyspnea) Blood tinged sputum Cyanosis Elevated pulmonary “WEDGE” pressure (PCWP) www.freelivedoctor.com
- 24. RIGHT Heart Failu re FATIGUE “ Dependent” edema JVD Hepatomegaly (congestion) ASCITES, PLEURAL EFFUSION GI Cyanosis Increased peripheral venous pressure (CVP) www.freelivedoctor.com
- 27. www.freelivedoctor.com T ricuspid atresia 1 120 T otal anomalous pulmonary venous connection 1 136 T runcus arteriosus 4 388 Transposition of great arteries 4 388 Aortic stenosis 4 396 Atrioventricular septal defect 5 492 Coarctation of aorta 5 577 T etralogy of Fallot 7 781 Patent d uctus arteriosus 8 836 Pulmonary stenosis 10 1043 Atrial septal d efect 42 4482 Ventricular septal d efect % Incidence per Million Live Births Malformation
- 61. www.freelivedoctor.com Often small platelet aggregates or thrombi and/or thromboemboli Frequent Usually severe Sudden death Widely variable, may be absent, partial/complete, or lysed Variable Variable Subendocardial myocardial infarction Occlusive Frequent Variable Transmural myocardial infarction Nonocclusive, often with thromboemboli Frequent Variable Unstable angina No No >75% Stable angina Plaque-Associated Thrombus Plaque Disruption Stenoses Syndrome Coronary Artery Pathology in Ischemic Heart Disease
- 64. MYOCARDIAL RESPONSE www.freelivedoctor.com >1 hr Microvascular injury 20–40 min Irreversible cell injury 40 min to 10% of normal 10 min to 50% of normal ATP reduced <2 min Loss of contractility Seconds Onset of ATP depletion Time Feature
- 65. PROGRESSION OF NECROSIS www.freelivedoctor.com
- 82. Diseases of the Pulmonary Parenchyma Chronic obstructive pulmonary disease Diffuse pulmonary interstitial fibrosis Pneumoconioses Cystic fibrosis Bronchiectasis Diseases of the Pulmonary Vessels Recurrent pulmonary thromboembolism Primary pulmonary hypertension Extensive pulmonary arteritis (e.g., Wegener granulomatosis) Drug-, toxin-, or radiation-induced vascular obstruction Extensive pulmonary tumor microembolism www.freelivedoctor.com
- 83. www.freelivedoctor.com Disorders Affecting Chest Movement Kyphoscoliosis Marked obesity (pickwickian syndrome) Neuromuscular diseases Disorders Inducing Pulmonary Arterial Constriction Metabolic acidosis Hypoxemia Chronic altitude sickness Obstruction to major airways Idiopathic alveolar hypoventilation
- 86. AORTIC STENOSIS 2X gradient pressure LVH, ischemia Cardiac decompensation, angina, CHF 50% die in 5 years if angina present 50% die in 2 years if CHF present www.freelivedoctor.com
- 92. ACUTE: -Inflammation -Aschoff bodies -Anitschkow cells -Pancarditis -Vegetations on chordae tendinae at leaflet junction CHRONIC: THICKENED VALVES COMMISURAL FUSION THICK, SHORT, CHORDAE TENDINAE www.freelivedoctor.com
- 99. www.freelivedoctor.com Splinter hemorrhages, Janeway lesions (palms, soles), Osler’s “nodes” (raised), Roth’s spots (eye)
- 106. www.freelivedoctor.com Splinter hemorrhages, Janeway lesions (palms, soles), Osler’s “nodes” (raised), Roth’s spots (eye)
- 108. Path: 4 chamber dilatation Hypertrophy Interstitial Fibrosis DCM www.freelivedoctor.com
- 109. Arrhythmogenic Right Ventricular Cardiomyopathy (Arrhythmogenic Right Ventricular Dysplasia) This is an uncommon dilated cardiomyopathy predominantly RIGHT ventricle. So is NAXOS syndrome. www.freelivedoctor.com
- 113. LYMPHOCYTIC INFILTRATES are the USUAL pattern of ALL myocarditis, but eosinophils, giant cells, and even trypanosomes can be seen occasionally www.freelivedoctor.com
- 122. CARDIAC TRANSPLANT PATHOLOGY www.freelivedoctor.com
Notas del editor
- This is the chapter outline.
- This is a section from “Shotgun Histology”, in other words, the terms on the left describe the entire myocardium. Atrial natriuretic peptide (ANP), atrial natriuretic factor (ANF), atrial natriuretic hormone (ANH), or atriopeptin, is a powerful vasodilator, and a protein (polypeptide) hormone secreted by heart muscle cells. It is involved in the homeostatic control of body water, sodium, potassium and fat (adipose tissue). It is released by muscle cells in the upper chambers (atria) of the heart (atrial myocytes), in response to high blood pressure. ANP acts to reduce the water, sodium and adipose loads on the circulatory system, thereby reducing blood pressure.
- The specialized myocytes of the heart’s conduction system, running sub-endocardially, have this unique appearance.
- Whichever artery winds up supplying the posterior interventricular septum is said to be “DOMINANT”
- The myocardial perfusion is a good test of coronary artery and myocardial function.
- These features are seen so commonly in autopsies of elderly people no matter what they died from. Also keep in mind that most people who do not die ACUTELY, die in cardiac failure.
- One very key philosophical question is whether atherosclerosis is part of aging or not. We can leave that for the philosophers.
- The pigment which accumulates with age is called lipofucsin, and caused the heart to appear “browner” than normal. This is called “brown” atrophy of the heart.
- This is the same analogy as the “straw” we talked about in the last chapter on blood vessels. You can classify cardiac diseases functionally into these 5 “pump” categories, like we had only 2 categories with the blood vessels described as straws or conduits.
- Very FEW hearts of elderly people at autopsy weigh the normal 250-300 gm. Atherosclerotic or CHF hearts weigh twice as much, hypertensive hearts weight three times as much, and cardiomyopathic hearts often weigh more.
- A good general diagram.
- Note that not only is the FIBER thick, but so are the nuclei. Note squaring off of the nuclei, so called “BOXCAR” effect.
- Can you understand why all of these findings can be related to LEFT sided heart failure? Ans: YES, primarily PULMONARY.
- Can you understand why all of these findings can be related to RIGHT sided heart failure? Ans: YES, primarily STSTEMIC.
- Does this look like it covers all bases? Ans: YES
- Do the NAMES of these congenital heart conditions adequately describe the pathology? Ans: YES Why have I highlighted the “D”s and the “T”s? Ans: D = L shunt, T= R L shunt (cyanosis, or “blue” babies).
- LEFT to RIGHT SHUNTS, NON-cyanotic
- All the R L congenital shunts are CYANOTIC, and have T’s in their names.
- CLASSICAL “TETROLOGY” of FALLOT: 1) VSD, large 2) OBSTRUCTION to RV flow 3) Aorta OVERRIDES the VSD 4) RVH
- CHRONIC plaque PLUS acute thrombosis = Acute coronary syndromes.
- Why does the necrosis spread from the endocardium to the pericardium (i.e., epicardium)?
- A chamber wall is only as thick as it has to be, i.e., more pressure more thickness
- Answer: owing to left atrial enlargement
- Answer: lenticulostriate in basal ganglia most susceptible to hypertensive CVA
- As the alveoli EXPAND in COPD, the arterioles NARROW!
- A reasonably logical way of looking at COR PULMONALE, or RIGHT HEART FAILURE
- Why do BOTH stenosis and regurgitation cause hypertrophy of the chamber proximal to the valve?
- A GREAT classical sydenham chorea (St. Vitus “Dance”) can be seen at www.youtube.com/watch?v=RnxqqW_nH0k
- Vegetations: 1) rheumatoid = small, 2) infectious = big, 3) lupus ( Libman-Saks) = BOTH sides
- Another diagram which shows “quantification” of a diagnosis
- Splinter hemorrhages, Janeway lesions (palms, soles), Osler’s “nodes” (raised), Roth’s spots (eye)
- Note the three FUNCTIONAL classes on the RIGHT
- A “restrictive” cardiomyopathy is a wall which is NOT thickened or dilated necessarily, but RIGID in diastolic relaxation.
- The “bread and butter” pericarditis is classically and most often described in uremia or pericardial infections. What is the exudate? Ans: Fibrin